What is the efficacy of thrombolytic therapy for acute ischemic stroke (AIS)?

Answer

In a study assessing the use, temporal trends, and outcomes of interhospital transfer after tPA use (drip-and-ship method) to those of conventional (front door) thrombolysis in 44,667 patients with AIS, Sheth et al found that patients treated by the drip-and-ship method had significantly lower National Institutes of Health (NIH) Stroke Scale scores when recorded.
[45] Patients treated by the drip-and-ship method also showed slightly higher rates of crude in-hospital mortality (10.9%) and sICH (5.7%), which persisted after risk adjustment.

In a study evaluating the influence of prestroke cognitive impairment (PSCI) on outcomes in 205 stroke patients treated with IV rtPA, Murao et al found that the 62 patients (30.2%) who met criteria for PSCI, though they had more sICH and were less frequently independent after 3 months, did not differ from the others for any endpoint after adjustment for age, baseline NIH Stroke Scale score, and onset-to-needle time.
[46] Pooled analysis found no association of PSCI with any endpoint. Their conclusion was that ischemic stroke patients with PSCI should receive rtPA if eligible, but this conclusion cannot be extended to severe cognitive impairment or severe strokes.